Lescan Mario, Dimov Aleksandar, Turchino Davide, Toma Alexandru, Scheumann Johannes, Berger Tim, Kreibich Maximilian, Gottardi Roman, Czerny Martin, Kondov Stoyan
Department of Cardiovascular Surgery, Heart Centre Freiburg University, 79106 Freiburg, Germany.
Faculty of Medicine, Albert Ludwig's University of Freiburg, 79110 Freiburg, Germany.
J Clin Med. 2025 Jul 8;14(14):4830. doi: 10.3390/jcm14144830.
: Physician-modified endografts (PMEGs) have emerged as a treatment option for complex aortic pathologies. Uncertainty remains regarding the modification techniques and the most suitable materials for customization of fenestrated endografts. The aim of this study was to evaluate CE-marked endovascular aortic repair (EVAR) devices and suitable materials for device modification in PMEGs for juxtarenal and pararenal aortic pathologies. : This single-center observational study included patients treated with the physician-modified TREO (Terumo Aortic, Inchinnan, UK) device between April and December 2024. All patients had aortic ruptures or symptomatic aneurysms and unfavorable anatomy or severe comorbidities, making standard EVAR and open repair unsuitable. Procedural data were recorded and analyzed, including in-hospital outcomes. The "wire visibility" and "sheath-wire contrast" of endografts were assessed under fluoroscopy, and different resheathing techniques were compared. : Technical success was achieved in all five patients. The number of fenestrations per patient was 2.6 (range: 1-4). In one patient (1/5), type Ib and type IIIc endoleaks were observed postoperatively, requiring reintervention. No in-hospital mortality occurred. The ICU and hospital stay were 24 h (range: 18-40 h) and 8 days (range: 6-20 days), respectively. Moreover, the One SNARE wire was identified as the wire with the highest "wire visibility", and Endurant II showed the best "sheath-wire contrast". Resheathing with the dedicated crimping device was superior to the tape-assisted method. : The TREO platform, in synergy with suitable additional materials, offers a viable solution for urgent aortic pathologies requiring PMEGs. Continued refinement of materials and procedural standardization could enhance the long-term outcome.
医生改良型腔内移植物（PMEGs）已成为治疗复杂主动脉病变的一种选择。关于开窗型腔内移植物定制的改良技术和最合适的材料仍存在不确定性。本研究的目的是评估用于肾周和肾旁主动脉病变的PMEGs中带有CE标志的血管腔内主动脉修复（EVAR）装置以及适合装置改良的材料。
这项单中心观察性研究纳入了2024年4月至12月期间接受医生改良型TREO（泰尔茂主动脉，英国因钦南）装置治疗的患者。所有患者均有主动脉破裂或有症状的动脉瘤，且解剖结构不佳或有严重合并症，使得标准EVAR和开放修复不适用。记录并分析了手术数据，包括住院结局。在荧光透视下评估腔内移植物的“导丝可视性”和“鞘管-导丝对比度”，并比较了不同的重新鞘管置入技术。
所有5例患者均取得技术成功。每位患者的开窗数量为2.6个（范围：1 - 4个）。1例患者（1/5）术后观察到Ib型和IIIc型内漏，需要再次干预。未发生住院死亡。重症监护病房（ICU）和住院时间分别为24小时（范围：18 - 40小时）和8天（范围：6 - 20天）。此外，One SNARE导丝被确定为“导丝可视性”最高的导丝，Endurant II显示出最佳的“鞘管-导丝对比度”。使用专用压接装置进行重新鞘管置入优于胶带辅助方法。
TREO平台与合适的附加材料协同作用，为需要PMEGs的紧急主动脉病变提供了可行的解决方案。材料的持续改进和手术标准化可改善长期结局。
